Pox (3 page)

No reliable figures exist to quantify the overall damage done by small-pox to American lives, commerce, and property during these epidemic years. The U.S. Public Health and Marine-Hospital Service, the federal disease-control agency, conceded that its smallpox statistics were woefully incomplete. The federal officials dutifully published the data they received from state and local health boards, but in many states those agencies were just coming into their own. Many smallpox-infected communities lacked the will or the wherewithal to accurately report cases of infectious disease.

Still, the admittedly spotty statistics of the federal health service suggest the broad chronological arc of the epidemics. At the beginning of 1898, smallpox was largely absent in the United States, apart from a few trouble spots, mostly in the South, including Birmingham, Alabama, and a hard-bitten Appalachian coal town called Middlesboro, Kentucky. As Surgeon General Walter Wyman of the Public Health and Marine-Hospital Service recalled, “[I]t was during the winter of 1898–99 that the disease began to assume great proportions.” In 1899, the service reported more than 12,000 cases, from all over the South, followed by 15,000 cases, now in the mid-western states, too, in 1900. In 1901, the number of new cases surged to nearly 39,000. According to the
Medical News
, by then the distribution of smallpox in the United States had become “alarmingly general.” In 1902—the year Wyman would remember as “the high-water mark” of the epidemics—the service counted 59,000 new cases. The agency tallied another 42,590 new cases in 1903. By the end of that year, the surgeon general assured the nation that “the disease has spent its force and will now continue to decrease until it practically disappears.” In fact, smallpox did taper off dramatically in 1904, but the disease did not disappear. Smallpox would continue to trouble American communities until the last reported U.S. case occurred in 1949. All told, during the five-year wave of epidemics around the turn of the century, the federal service counted 164,283 American cases of smallpox. The actual number of cases may have exceeded five times that figure.
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But for American public health officials, the truly stunning statistic from those epidemics was the body count. It was shockingly
low
. According to the federal health service reports, only 5,627 people died. Again, the mortality figure was impressionistic at best; the Census Bureau independently reported nearly 4,000 smallpox fatalities in 1900 alone (more than five times the health service's figure for that year). Still, all agreed that the death toll was astonishingly, inexplicably, blessedly small. If smallpox had measured up to its historical virulence, the epidemics of 1898–1903 would have killed at least 50,000 Americans .
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Although in some places smallpox proved as destructive as ever, in the vast majority of American epidemics after 1898, the disease seemed to have lost its lethal force. Vaccinal protection could not explain the phenomenon: when the smallpox came, most Americans had not been vaccinated in years. It seemed a new “mild type” of smallpox had appeared on the epidemiological landscape, the likes of which the “civilized” nations of Europe, England, and the United States had never seen. No one could say how long the new pox would remain mild. Many medical authorities expected the disease to revert to classic, malignant smallpox at any moment. For American health officials, the low mortality rate posed the greatest medical mystery—and the toughest political challenge—of the turn-of-the-century smallpox epidemics.
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The sudden appearance of a new mild form of smallpox altered the political calculus of compulsory vaccination—a measure that had been none too popular in late nineteenth-century America. To this day, medical experts consider smallpox vaccine, which contains a bovine virus called
vaccinia
, “the least safe vaccine available.” Serious complications, including postvaccinial encephalitis and death, are rare: scientists expect one million vaccinations to cause three to five serious reactions. But milder reactions—rashes, fatigue, headache, fever, painfully tender arms—are common. In 1900, vaccination carried significantly greater dangers. The government compelled vaccination, but did little to ensure that American vaccine makers produced safe, effective vaccine. Newspaper stories, medical texts, and popular rumors linked vaccination to syphilis, tetanus, and the ubiquitous “sore arms” that caused countless American breadwinners to lose days or even weeks of work. Because the new pox killed less than 1 percent of the people whom it infected, many laypeople and even doctors refused to believe it was smallpox at all. In the absence of a recognizably horrific case of smallpox, many failed to see the benefit of vaccination. Many saw vaccination as the greater risk to life and limb. And their resistance to compulsory vaccination would help persuade the federal government to impose new regulatory controls on the American vaccine industry.
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But reasonable health concerns do not alone explain the widespread opposition to compulsory vaccination at the turn of the twentieth century. Antivaccinationism was an international phenomenon, but everywhere it reflected the social divisions and political tensions of its time and place. The roots of American antivaccination sentiment ran deep and wide. Race stymied smallpox control, as white taxpayers, particularly in the South, balked at paying for vaccine to protect blacks; meanwhile, African Americans rightly mistrusted government vaccinators whose chief aim was to protect the white community. Christian Scientists viewed compulsory vaccination as a violation of religious freedom. Physicians who practiced popular forms of alternative medicine decried government vaccination orders as yet another example of creeping “state medicine.” Parents resented school vaccination mandates for encroaching on their domestic authority and for violating their children's innocent bodies. Antivaccination propagandists traced compulsory vaccination to a corrupt conspiracy between health officials, lawmakers, and vaccine manufacturers. On the broadest level, though, the vaccination question revealed a sharp uneasiness toward the authority of medicine and the power of the state at the height of the Progressive Era, a period of time when both institutions were reaching more ambitiously than ever before into American life.
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Contrary to the
Times
's assertion, then, an unquestioning submission to vaccination was anything but the “common sense” of the American people during these smallpox outbreaks—even in the many places where local and state governments made such submission compulsory by law. Ordinary Americans responded to government vaccination orders in a variety of ways, ranging from ready compliance to violent riots. They organized antivaccination societies, conducted legislative campaigns (some of them successful) to repeal state vaccination laws, and flooded the courts with lawsuits challenging compulsory vaccination as a violation of their constitutional rights. More often, people resisted public health authority in more private, mundane ways: by concealing sick family members at home, forging vaccination certificates, or simply dodging their legal duty to be vaccinated. In the aftermath of this nationwide fight against smallpox, the United States would remain, in the words of one of the nation's preeminent public health experts, “the least vaccinated of any civilized country.”
²⁵

The aim of this book is to explain why this was so. To trace the origins and broader significance of smallpox and the “vaccination question” in Progressive Era America, I have found it necessary to stray far from the familiar narrative conventions of the epidemic tale. This is not a story of rising body counts and medical heroics—though the changing lethal power of the smallpox virus, the emergence of the modern vaccine industry, and the strenuous work of public health officials are all central to this narrative. Nor is the story told in these pages a comforting tale of human solidarity springing up in unexpected places: the tragic disaster that forces the people of a community to overcome their differences and work together to survive and rebuild. The smallpox outbreaks of the turn of the century did occasion such moments, and they are remembered here. But the history of these American epidemics is, inescapably, a history of violence, social conflict, and political contention. And that made all the difference .
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America's turn-of-the-century war against smallpox sparked one of the most important civil liberties struggles of the twentieth century. To readers versed in the scholarly literature about American civil liberties, this claim may sound curious (or even spurious). According to the conventional text-book narrative, the modern era of civil liberties properly begins with the famous free speech cases of the post–World War I era, when the U.S. Supreme Court established new First Amendment protections for political dissent. But contemporaries of the period, including no less a giant of the American legal realm than Justice Oliver Wendell Holmes, Jr., of the United States Supreme Court, recognized that the celebrated free speech battles reprised constitutional questions that the vaccination struggle had raised for Americans two decades earlier. As Justice Holmes wrote in a 1918 letter to Judge Learned Hand, “Free speech stands no differently than freedom from vaccination.”
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In a burst of litigation arising from the smallpox epidemics, the critics of compulsion had carried the vaccination question all the way to the U.S. Supreme Court in 1905. They raised a broad set of questions about the nature of institutional power and the bounds of personal liberty in a modern urban-industrial nation. Their demands went far beyond the right to speak out against the government. The critics of compulsory vaccination insisted that the liberty protected by the Constitution also encompassed the right of a free people to take care of their own bodies and children according to their own medical beliefs and consciences. It was a bold but deeply problematic claim. And it brought the opponents of compulsory vaccination into direct conflict with the agents of an emerging interventionist state, whose progressive purpose was to use the best scientific knowledge available to regulate the economy and the population in the interests of the social welfare.
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This, then, is the story of a largely forgotten American smallpox epidemic that killed relatively few people but left a surprisingly deep impression on society, government, and the law. The story begins where the epidemics did, in the fields and work camps of the New South.

“To begin at the beginning, and I think it was the beginning,” Dr. Henry F. Long wrote in his 1898 report to the North Carolina Board of Health, “the first smallpox experience we, of Iredell, had, was when the negro Perkins made his way from Neal's camp, on the M & M Railroad, to Charlotte.”
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Henry Long was the superintendent of health of Iredell County, an area of low ridges and valleys known for its loamy soil and its many creeks. Most of the citizens were North Carolina natives, like their mothers and fathers before them. Long himself carried on the medical practice established by his father in Statesville, an old town of wide, elm-lined streets that served as the county seat. In the past twenty years, the hum of industry had altered the rhythm of life in the Piedmont. Farming families and respectable townspeople like the Longs had had to accustom themselves to growing numbers of wage earners and outsiders. Apart from farming wheat, the people now spent their days making furniture, processing tobacco, tending textile machines, working on the railroads, and, as ever, raising families. Until the winter of 1898, most folks in Iredell County had never seen a case of smallpox. Then that, too, changed.
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Harvey Perkins was fifty-seven years old that February, when he left his home in Pelzer, South Carolina, and traveled some one hundred and fifty miles north and east to seek work on the Mocksville & Mooresville extension of the Southern Railway. He arrived, the fever already upon him, at Neal's Camp, one of the turn-of-the-century South's ubiquitous railroad construction camps. He spent the night in a hut with two other laborers. As Long explained, patients in the preeruptive stage of smallpox already battled their unseen foe: “The pulse is strong, full and bounding. . . . The patient is restless and distressed and when sleep is possible has frightful dreams.” When morning broke, Perkins noticed the first spots on his face. Guessing at their significance, and fearing that his new bosses would confine him in quarantine, he left camp without a word and slipped into the woods.
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All Harvey Perkins wanted was to get home to Pelzer, maybe by picking up a train in Charlotte, forty miles south of Neal's Camp. By the time Perkins walked the twelve miles to Mooresville, in southern Iredell County, the eruption was visible to anyone who cared to look him in the face. But a sick old black man did not usually attract much notice, especially from white people. Perkins spent the night. He resumed his journey the next day. He was just two miles from Charlotte when his strength finally gave out and he “fell by the wayside.” A pair of bicyclists found him in the woods, his face and body covered with pocks. Perkins warned them not to come near. Local authorities transported him to the city pesthouse, a makeshift isolation hospital on the outskirts of Charlotte in Mecklenburg County, where Perkins discovered he was not alone. Dr. Long had not, in fact, begun at the beginning.
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Smallpox had been stalking North Carolina's southern border for months, maybe longer. Health officials in the lower South thought the disease confined to the African American sections of a few cities and to the dispersed settlements of black farmers, laborers, and families. Since the end of slavery, the white medical profession had paid African Americans little notice and offered little aid. Within the past year or so, smallpox had broken out, seemingly without warning, in parts of Florida, Alabama, Georgia, South Carolina, Tennessee, Kentucky, and Virginia. Some white physicians and laypeople dismissed the disease as a peculiar negro malady: “Nigger itch,” they called it. But Dr. Long and other seasoned public health officials knew better. “So far the disease has been almost exclusively confined to negroes,” said the Kentucky Board of Health, in a circular titled “Warning Against Smallpox,” “but this exemption of the white race cannot long be hoped for if it continues to spread.”
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